COVID-19: Did We See the Pandemic Coming?

It was the New year eve of 2020, when WHO’s China office encountered the first reports of an unknown-virus, causing pneumonia cases in the Wuhan city of China, constituting nearly 11 million population. Soon, the epidemic, that initially remained within China’s boundaries, became a global pandemic. While synthesizing this piece, 6,40,589 confirmed coronavirus cases and 29,848 deaths have been reported (Coronavirus Resource Centre, John Hopkins University & Medicine) and these numbers are fast escalating. The outbreak has been reported from across the world now, with the United States, Italy, Iran, Spain, and South Korea being the worst hit. Unfortunately, in Italy, the death toll has even surpassed that of China, and the United States registers the maximum positive COVID-19 cases across the world.

Fig.1.1 Death Cases in China and Italy

Source: BBC News and John Hopkins Coronavirus Dashboard, on March 20, 2020

Note: Y-axis represents the death cases.

In India, there have been 933 confirmed cases and 20 deaths till March 28. Although the virus has hit India towards the end of January, the cases have fast escalated, putting the normal daily functioning to a halt. This has especially become quite intimidating for the hustle-bustle megacities and corporations. Work-from-home has become the new norm, educational institutions have been closed and promoting video-lectures, international travels have been prohibited, public gatherings have been banned, shopping malls/cinema halls have been shut and international flights have been suspended until 14th April. In fact, the country is observing a complete lockdown after Government announcement to curb the contagion.

Was the Outbreak Foreseen? Perhaps, Yes!

Event-201--a pandemic preparedness exercise program-- witnessed the public health emergency questions; exactly akin to what we are facing today. In October 2019, Government Officials, Public Health professionals and business experts in a round-table gathering in New York, staged response to the global outbreak of a never-seen-before, a completely hypothetical Coronavirus. The expert group in their 3.5 hours simulation exercise; despite to their best capabilities and efforts failed to prevent the frictional virus from killing 65 million people. This hypothetical coronavirus at the center of Event-201 simulation, which was a collaboration between the Johns Hopkins Center for Health Security, the World Economic Forum, and the Bill and Melinda Gates Foundation — was called coronavirus acute pulmonary syndrome or CAPS. It started with pigs in Brazil before spreading to farmers, with flu-like symptoms and then to impoverished neighborhoods of Southern America. The devastating economic and social impacts, from cancellations of travel bookings to spread of rumors on social networking sites were outlined in this exercise and within two-quarters CAPS had made its way across the globe, and by the 18-month, it had killed 65 million people and triggered a global financial crisis. Hence, the world wasn’t really prepared for another pandemic! Eerily, the COVID-19 outbreak has shockingly similar similarities. The virus from China’s Wuhan has gone global and already started showing strong signals of the ensuing financial crisis with a plummeting stock market, massive adverse impact on the hospitality industry across countries and limited trade.

During the hypothetical simulation, the discussion hovered around building up stockpiles of medical supplies (masks, sanitizers, medicines, etc.) to restrict shortages, ensuring governments and transportation agencies on keeping goods flowing to ensure those supplies get where they are needed. “Global financing for pandemics to be reassessed — in the simulation, there was simply not enough money as CAPS ran roughshod and no stringent mechanisms to fight fake news, conspiracies, and propaganda campaigns”. Not much surprisingly, all these foreseen situations have emerged in case of the actual outbreak too because we were not prepared! Misinformation about COVID-19 is proliferating across houses around the globe because of social media. It began with COVID-19 being linked to China’s biowarfare program then brimming YouTube, Instagram and twitter handle with gels and powders that can fight against Coronavirus. For instance, the WHO has recently busted the myth that the use of garlic, mouthwash, sesame oil can dodge the virus. India, too, is no exception in spreading such myths, like, using Unani or homeopathy medicine for abating the virus.

Further, there have been severe shortages of masks and medical apparatus, so much so, that frontline staff in the US—doctors and nurses—have been asked to reuse the masks, including surgical masks, which offer no protection as recently mentioned by Executive Director of National Nurses United, Bonnie Castillo. Government leaders are worrying “the pandemic could stretch hospitals across the US to their breaking point while medical equipment shortages threaten to put doctors, nurses, and patients at risk”. India, however, is being lauded for maintaining a proactive stance but we are still not aware of the magnitude of the disease. Although, India has not really witnessed the viral rampage that has been registered in Italy and South Korea has been recently experiencing, but India needs to gear up giving the country’s frailing healthcare infrastructure. In Italy, cases have spiraled from single digits to tens of thousands in three weeks’ time and the upsurge inpatient count has already started pushing the capacity of hospitals. Patient prioritization has become common, where beds and ventilators are rationed-off and allocated to those with better survival likelihood. Similar, rationing decisions have come to fore in case of China’s Wuhan as well. It is estimated that in the U.S. too, even if all beds are assumed to available, one hospital bed will be competed by nearly six critically-ailing patients in a medium-level outbreak.

If this is the situation in the US, Italy, and China which have 2.8,3.2, and 4.3 beds per 1000 people, one can envisage how much prepared India is with 1 bed per 1000 population; one million hospital beds and about one lakh Intensive Care Unit beds.

What’s next?

COVID-19 has been compared by some to the 1918 influenza epidemic that took more than 30 million lives. Although efforts are strong to control the pandemic, only time will tell. However, there are important takeaways from earlier public health emergencies. First, security for healthcare professionals. Second, a public-private collaboration in testing and delivering care in emergency times. Third, developing a robust international stockpile of vaccinations. This is imperative to ensure that supplies reach in low and middle resource settings in catastrophic times, regardless of whether they have the capacity to produce supplies domestically. “Countries with national supplies or domestic manufacturing capabilities should commit to donating some supply/product to this virtual stockpile”. It is much-known that during a devastating outbreak, countries are reluctant to part with scarce medical resources, hence, a strategy of maintaining adequate supplies before a pandemic knocks the door should really kick-in.

Despite claims, a vaccine for COVID-19 doesn’t seem to be coming soon. Bringing such vaccines to the market requires potential vaccination to undergo multiple stages of testing for effectiveness, and safety. After passing all such tests, manufacturing at a massive scale to be utilized globally requires time. It cannot be debunked that research towards the development of a vaccine for COVID-19 is happening at a breakneck speed. As per the BBC’s latest news, nearly 20 vaccines are in the development stage. While the majority of them are at the animal testing phase and yet to begin trials on humans which is not expected before the end of the current year; there is one vaccine that is already being tested on humans by skipping the animal trial stage and it's yet to come up with effectiveness and safety results. Until then, social distancing will remain the key to curb the spread.

Navneet K. Manchanda and Kamal Chaudhary are respectively Consultants at The World Bank and Ph.D. Scholar at Jawaharlal Nehru University, New Delhi, India. he views expressed in this insight piece are those of the author and do not necessarily reflect the official policy or position of the institutions they represent.